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Álvarez-Rodríguez A, Jin BK, Radwanska M, Magez S. Recent progress in diagnosis and treatment of Human African Trypanosomiasis has made the elimination of this disease a realistic target by 2030. Front Med (Lausanne) 2022; 9:1037094. [PMID: 36405602 PMCID: PMC9669443 DOI: 10.3389/fmed.2022.1037094] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
Abstract
Human African Trypanosomiasis (HAT) is caused by unicellular flagellated protozoan parasites of the genus Trypanosoma brucei. The subspecies T. b. gambiense is mainly responsible for mostly chronic anthroponotic infections in West- and Central Africa, accounting for roughly 95% of all HAT cases. Trypanosoma b. rhodesiense results in more acute zoonotic infections in East-Africa. Because HAT has a two-stage pathogenesis, treatment depends on clinical assessment of patients and the determination whether or not parasites have crossed the blood brain barrier. Today, ultimate confirmation of parasitemia is still done by microscopy analysis. However, the introduction of diagnostic lateral flow devices has been a major contributor to the recent dramatic drop in T. b. gambiense HAT. Other techniques such as loop mediated isothermal amplification (LAMP) and recombinant polymerase amplification (RPA)-based tests have been published but are still not widely used in the field. Most recently, CRISPR-Cas technology has been proposed to improve the intrinsic diagnostic characteristics of molecular approaches. This will become crucial in the near future, as preventing the resurgence of HAT will be a priority and will require tools with extreme high positive and negative predicted values, as well as excellent sensitivity and specificity. As for treatment, pentamidine and suramin have historically been the drugs of choice for the treatment of blood-stage gambiense-HAT and rhodesiense-HAT, respectively. For treatment of second-stage infections, drugs that pass the blood brain barrier are needed, and melarsoprol has been effectively used for both forms of HAT in the past. However, due to the high occurrence of post-treatment encephalopathy, the drug is not recommended for use in T. b. gambiense HAT. Here, a combination therapy of eflornithine and nifurtimox (NECT) has been the choice of treatment since 2009. As this treatment requires IV perfusion of eflornithine, efforts were launched in 2003 by the drugs for neglected disease initiative (DNDi) to find an oral-only therapy solution, suitable for rural sub-Saharan Africa treatment conditions. In 2019 this resulted in the introduction of fexinidazole, with a treatment regimen suitable for both the blood-stage and non-severe second-stage T. b. gambiense infections. Experimental treatment of T. b. rhodesiense HAT has now been initiated as well.
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Affiliation(s)
- Andrés Álvarez-Rodríguez
- Laboratory for Biomedical Research, Ghent University Global Campus, Incheon, South Korea
- Laboratory of Cellular and Molecular Immunology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Bo-Kyung Jin
- Laboratory for Biomedical Research, Ghent University Global Campus, Incheon, South Korea
| | - Magdalena Radwanska
- Laboratory for Biomedical Research, Ghent University Global Campus, Incheon, South Korea
- Department of Biomedical Molecular Biology, Ghent University, Ghent, Belgium
| | - Stefan Magez
- Laboratory for Biomedical Research, Ghent University Global Campus, Incheon, South Korea
- Laboratory of Cellular and Molecular Immunology, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Biochemistry and Microbiology, Ghent University, Ghent, Belgium
- *Correspondence: Stefan Magez,
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Wamboga C, Matovu E, Bessell PR, Picado A, Biéler S, Ndung’u JM. Enhanced passive screening and diagnosis for gambiense human African trypanosomiasis in north-western Uganda - Moving towards elimination. PLoS One 2017; 12:e0186429. [PMID: 29023573 PMCID: PMC5638538 DOI: 10.1371/journal.pone.0186429] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 09/29/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction The incidence of gambiense human African trypanosomiasis (gHAT) in Uganda has been declining, from 198 cases in 2008, to only 20 in 2012. Interruption of transmission of the disease by early diagnosis and treatment is core to the control and eventual elimination of gHAT. Until recently, the format of available screening tests had restricted screening and diagnosis to central health facilities (passive screening). We describe a novel strategy that is contributing to elimination of gHAT in Uganda through expansion of passive screening to the entire population at risk. Methodology / Principal findings In this strategy, patients who are clinically suspected of having gHAT at primary health facilities are screened using a rapid diagnostic test (RDT), followed by parasitological confirmation at strategically located microscopy centres. For patients who are positive with the RDT and negative by microscopy, blood samples undergo further testing using loop-mediated isothermal amplification (LAMP), a molecular test that detects parasite DNA. LAMP positive patients are considered strong suspects, and are re-evaluated by microscopy. Location and upgrading of facilities to perform microscopy and LAMP was informed by results of georeferencing and characterization of all public healthcare facilities in the 7 gHAT endemic districts in Uganda. Three facilities were upgraded to perform RDTs, microscopy and LAMP, 9 to perform RDTs and microscopy, and 200 to screen patients with RDTs. This reduced the distance that a sick person must travel to be screened for gHAT to a median distance of 2.5km compared to 23km previously. In this strategy, 9 gHAT cases were diagnosed in 2014, and 4 in 2015. Conclusions This enhanced passive screening strategy for gHAT has enabled full coverage of the population at risk, and is being replicated in other gHAT endemic countries. The improvement in case detection is making elimination of the disease in Uganda an imminent possibility.
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Affiliation(s)
| | - Enock Matovu
- College of Veterinary Medicine, Animal Resources and Biosecurity (COVAB), Makerere University, Kampala, Uganda
| | | | - Albert Picado
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Sylvain Biéler
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
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Schwarz NG, Loderstaedt U, Hahn A, Hinz R, Zautner AE, Eibach D, Fischer M, Hagen RM, Frickmann H. Microbiological laboratory diagnostics of neglected zoonotic diseases (NZDs). Acta Trop 2017; 165:40-65. [PMID: 26391646 DOI: 10.1016/j.actatropica.2015.09.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 08/03/2015] [Accepted: 09/04/2015] [Indexed: 02/06/2023]
Abstract
This review reports on laboratory diagnostic approaches for selected, highly pathogenic neglected zoonotic diseases, i.e. anthrax, bovine tuberculosis, brucellosis, echinococcosis, leishmaniasis, rabies, Taenia solium-associated diseases (neuro-/cysticercosis & taeniasis) and trypanosomiasis. Diagnostic options, including microscopy, culture, matrix-assisted laser-desorption-ionisation time-of-flight mass spectrometry, molecular approaches and serology are introduced. These procedures are critically discussed regarding their diagnostic reliability and state of evaluation. For rare diseases reliable evaluation data are scarce due to the rarity of samples. If bio-safety level 3 is required for cultural growth, but such high standards of laboratory infrastructure are not available, serological and molecular approaches from inactivated sample material might be alternatives. Multiple subsequent testing using various test platforms in a stepwise approach may improve sensitivity and specificity. Cheap and easy to use tests, usually called "rapid diagnostic tests" (RDTs) may impact disease control measures, but should not preclude developing countries from state of the art diagnostics.
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Sternberg JM, Gierliński M, Biéler S, Ferguson MAJ, Ndung'u JM. Evaluation of the diagnostic accuracy of prototype rapid tests for human African trypanosomiasis. PLoS Negl Trop Dis 2014; 8:e3373. [PMID: 25521120 PMCID: PMC4270746 DOI: 10.1371/journal.pntd.0003373] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 10/26/2014] [Indexed: 11/19/2022] Open
Abstract
Background Diagnosis of human African trypanosomiasis (HAT) remains a challenge both for active screening, which is critical in control of the disease, and in the point-of-care scenario where early and accurate diagnosis is essential. Recently, the first field deployment of a lateral flow rapid diagnostic test (RDT) for HAT, “SD BIOLINE HAT” has taken place. In this study, we evaluated the performance of “SD BIOLINE HAT” and two new prototype RDTs. Methodology/Principal Findings The performance of “SD BIOLINE HAT” and 2 prototype RDTs was tested using archived plasma from 250 Trypanosoma brucei gambiense patients, and 250 endemic controls. As well as comparison of the sensitivity and specificity of each device, the performance of individual antigens was assessed and the hypothetical performance of novel antigen combinations extrapolated. Neither of the prototype devices were inferior in sensitivity or specificity to “SD BIOLINE HAT” (sensitivity 0.82±0.01, specificity 0.97±0.01, 95% CI) at the 5% margins, while one of the devices (BBI) had significantly superior sensitivity (0.88±0.03). Analysis of the performance of individual antigens was used to model new antigen combinations to be explored in development of the next generation of HAT RDTs. The modelling showed that an RDT using two recombinant antigens (rLiTat1.5 and rISG65) would give a performance similar to the best devices in this study, and would also offer the most robust performance under deteriorating field conditions. Conclusions/Significance Both “SD BIOLINE HAT” and the prototype devices performed comparably well to one another and also to the published performance range of the card agglutination test for trypanosomiasis in sensitivity and specificity. The performance of individual antigens enabled us to predict that an all-recombinant antigen RDT can be developed with an accuracy equivalent to “ SD BIOLINE HAT.” Such an RDT would have advantages in simplified manufacture, lower unit cost and assured reproducibility. The most prevalent species of trypanosome causing human African trypanosomiasis (HAT), Trypanosoma brucei gambiense, presents a diagnostic challenge. While early diagnosis is essential for effective treatment and also to control transmission, symptoms are non-specific and parasitological diagnosis is laborious and technically difficult. Screening for HAT suspects has until now been done using the card agglutination test for trypanosomiasis (CATT), which requires a cold chain and equipment, making it difficult to deploy. Thus there is an urgent need for sensitive point of care diagnostic tests that are suitable for use in rural areas in terms of stability, simplicity and cost. We describe the evaluation of 3 rapid diagnostic tests (RDTs) for HAT based on lateral flow devices that detect antibodies against defined parasite antigens in blood samples. We demonstrate that the SD BIOLINE HAT RDT currently being deployed in HAT endemic regions, as well as two new prototype devices, are accurate in screening for HAT. By analysing the sensitivity of each of the antigens used in the devices tested, we predict that a highly sensitive RDT based on recombinant antigens can be developed. An all-recombinant antigen RDT offers significant benefits in manufacturing reproducibility and cost, and would dramatically simplify HAT diagnosis.
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Affiliation(s)
- Jeremy M. Sternberg
- Institute of Biological and Environmental Sciences, University of Aberdeen, Aberdeen, United Kingdom
- * E-mail:
| | - Marek Gierliński
- College of Life Sciences, University of Dundee, Dundee, United Kingdom
| | - Sylvain Biéler
- Foundation for Innovative New Diagnostics (FIND) Campus Biotech, Geneva, Switzerland
| | | | - Joseph M. Ndung'u
- Foundation for Innovative New Diagnostics (FIND) Campus Biotech, Geneva, Switzerland
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Sullivan L, Fleming J, Sastry L, Mehlert A, Wall SJ, Ferguson MAJ. Identification of sVSG117 as an immunodiagnostic antigen and evaluation of a dual-antigen lateral flow test for the diagnosis of human African trypanosomiasis. PLoS Negl Trop Dis 2014; 8:e2976. [PMID: 25033401 PMCID: PMC4102454 DOI: 10.1371/journal.pntd.0002976] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 05/12/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The diagnosis of human African trypanosomiasis (HAT) caused by Trypanosoma brucei gambiense relies mainly on the Card Agglutination Test for Trypanosomiasis (CATT). There is no immunodiagnostic for HAT caused by T. b. rhodesiense. Our principle aim was to develop a prototype lateral flow test that might be an improvement on CATT. METHODOLOGY/PRINCIPLE FINDINGS Pools of infection and control sera were screened against four different soluble form variant surface glycoproteins (sVSGs) by ELISA and one, sVSG117, showed particularly strong immunoreactivity to pooled infection sera. Using individual sera, sVSG117 was shown to be able to discriminate between T. b. gambiense infection and control sera by both ELISA and lateral flow test. The sVSG117 antigen was subsequently used with a previously described recombinant diagnostic antigen, rISG65, to create a dual-antigen lateral flow test prototype. The latter was used blind in a virtual field trial of 431 randomized infection and control sera from the WHO HAT Specimen Biobank. CONCLUSION/SIGNIFICANCE In the virtual field trial, using two positive antigen bands as the criterion for infection, the sVSG117 and rISG65 dual-antigen lateral flow test prototype showed a sensitivity of 97.3% (95% CI: 93.3 to 99.2) and a specificity of 83.3% (95% CI: 76.4 to 88.9) for the detection of T. b. gambiense infections. The device was not as good for detecting T. b. rhodesiense infections using two positive antigen bands as the criterion for infection, with a sensitivity of 58.9% (95% CI: 44.9 to 71.9) and specificity of 97.3% (95% CI: 90.7 to 99.7). However, using one or both positive antigen band(s) as the criterion for T. b. rhodesiense infection improved the sensitivity to 83.9% (95% CI: 71.7 to 92.4) with a specificity of 85.3% (95% CI: 75.3 to 92.4). These results encourage further development of the dual-antigen device for clinical use.
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Affiliation(s)
- Lauren Sullivan
- Division of Biological Chemistry and Drug Discovery, College of Life Sciences, University of Dundee, Dundee, United Kingdom
| | - Jennifer Fleming
- Division of Biological Chemistry and Drug Discovery, College of Life Sciences, University of Dundee, Dundee, United Kingdom
| | - Lalitha Sastry
- Division of Biological Chemistry and Drug Discovery, College of Life Sciences, University of Dundee, Dundee, United Kingdom
| | - Angela Mehlert
- Division of Biological Chemistry and Drug Discovery, College of Life Sciences, University of Dundee, Dundee, United Kingdom
| | | | - Michael A. J. Ferguson
- Division of Biological Chemistry and Drug Discovery, College of Life Sciences, University of Dundee, Dundee, United Kingdom
- * E-mail:
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Holzmuller P, Grébaut P, Semballa S, Gonzatti MI, Geiger A. Proteomics: a new way to improve human African trypanosomiasis diagnosis? Expert Rev Proteomics 2014; 10:289-301. [DOI: 10.1586/epr.13.14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Chappuis F, Alirol E, d’Acremont V, Bottieau E, Yansouni C. Rapid diagnostic tests for non-malarial febrile illness in the tropics. Clin Microbiol Infect 2013; 19:422-31. [DOI: 10.1111/1469-0691.12154] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 12/21/2012] [Accepted: 01/07/2013] [Indexed: 11/30/2022]
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Yansouni CP, Bottieau E, Lutumba P, Winkler AS, Lynen L, Büscher P, Jacobs J, Gillet P, Lejon V, Alirol E, Polman K, Utzinger J, Miles MA, Peeling RW, Muyembe JJ, Chappuis F, Boelaert M. Rapid diagnostic tests for neurological infections in central Africa. THE LANCET. INFECTIOUS DISEASES 2013; 13:546-58. [PMID: 23623369 DOI: 10.1016/s1473-3099(13)70004-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Infections are a leading cause of life-threatening neuropathology worldwide. In central African countries affected by endemic diseases such as human African trypanosomiasis, tuberculosis, HIV/AIDS, and schistosomiasis, delayed diagnosis and treatment often lead to avoidable death or severe sequelae. Confirmatory microbiological and parasitological tests are essential because clinical features of most neurological infections are not specific, brain imaging is seldom feasible, and treatment regimens are often prolonged or toxic. Recognition of this diagnostic bottleneck has yielded major investment in application of advances in biotechnology to clinical microbiology in the past decade. We review the neurological pathogens for which rapid diagnostic tests are most urgently needed in central Africa, detail the state of development of putative rapid diagnostic tests for each, and describe key technical and operational challenges to their development and implementation. Promising field-suitable rapid diagnostic tests exist for the diagnosis of human African trypanosomiasis and cryptococcal meningoencephalitis. For other infections-eg, syphilis and schistosomiasis-highly accurate field-validated rapid diagnostic tests are available, but their role in diagnosis of disease with neurological involvement is still unclear. For others-eg, tuberculosis-advances in research have not yet yielded validated tests for diagnosis of neurological disease.
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Affiliation(s)
- Cedric P Yansouni
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
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Sullivan L, Wall SJ, Carrington M, Ferguson MAJ. Proteomic selection of immunodiagnostic antigens for human African trypanosomiasis and generation of a prototype lateral flow immunodiagnostic device. PLoS Negl Trop Dis 2013; 7:e2087. [PMID: 23469310 PMCID: PMC3584999 DOI: 10.1371/journal.pntd.0002087] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 01/17/2013] [Indexed: 11/30/2022] Open
Abstract
Background The diagnosis of Human African Trypanosomiasis relies mainly on the Card Agglutination Test for Trypanosomiasis (CATT). While this test is successful, it is acknowledged that there may be room for improvement. Our aim was to develop a prototype lateral flow test based on the detection of antibodies to trypanosome antigens. Methodology/Principal Findings We took a non-biased approach to identify potential immunodiagnostic parasite protein antigens. The IgG fractions from the sera from Trypanosoma brucei gambiense infected and control patients were isolated using protein-G affinity chromatography and then immobilized on Sepharose beads. The IgG-beads were incubated with detergent lysates of trypanosomes and those proteins that bound were identified by mass spectrometry-based proteomic methods. This approach provided a list of twenty-four trypanosome proteins that selectively bound to the infection IgG fraction and that might, therefore, be considered as immunodiagnostic antigens. We selected four antigens from this list (ISG64, ISG65, ISG75 and GRESAG4) and performed protein expression trials in E. coli with twelve constructs. Seven soluble recombinant protein products (three for ISG64, two for ISG65 and one each for ISG75 and GRESAG4) were obtained and assessed for their immunodiagnostic potential by ELISA using individual and/or pooled patient sera. The ISG65 and ISG64 construct ELISAs performed well with respect to detecting T. b. gambiense infections, though less well for detecting T. b. rhodesiense infections, and the best performing ISG65 construct was used to develop a prototype lateral flow diagnostic device. Conclusions/Significance Using a panel of eighty randomized T. b. gambiense infection and control sera, the prototype showed reasonable sensitivity (88%) and specificity (93%) using visual readout in detecting T. b. gambiense infections. These results provide encouragement to further develop and optimize the lateral flow device for clinical use. Human African Trypanosomiasis is caused by infection with Trypanosoma brucei gambiense or T. b. rhodesiense. Preliminary diagnosis of T. b. gambiense infection relies mainly on a Card Agglutination Test for Trypanosomiasis (CATT), which has acknowledged limitations. New approaches are needed, first to identify new diagnostic antigens and, second, to find a more suitable platform for field-based immunodiagnostic tests. We took an unbiased approach to identify candidate diagnostic antigens by asking which parasite proteins bind to the antibodies of infected patients and not to the antibodies of uninfected patients. From this list of twenty-four candidate antigens, we selected four and from these we selected the one that worked the best in conventional immunodiagnostic tests. This antigen, ISG65, was used to make lateral flow devices, where a small sample of patient serum is added to a pad and thirty minutes later infection can be inferred by simple optical read out. This simple prototype device works as well as the CATT test and may be developed and optimized for clinical use in the field.
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Affiliation(s)
- Lauren Sullivan
- College of Life Sciences, University of Dundee, Dundee, United Kingdom
| | | | - Mark Carrington
- Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom
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Human african trypanosomiasis diagnosis in first-line health services of endemic countries, a systematic review. PLoS Negl Trop Dis 2012; 6:e1919. [PMID: 23209860 PMCID: PMC3510092 DOI: 10.1371/journal.pntd.0001919] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 10/09/2012] [Indexed: 11/19/2022] Open
Abstract
While the incidence of Human African Trypanosomiasis (HAT) is decreasing, the control approach is shifting from active population screening by mobile teams to passive case detection in primary care centers. We conducted a systematic review of the literature between 1970 and 2011 to assess which diagnostic tools are most suitable for use in first-line health facilities in endemic countries. Our search retrieved 16 different screening and confirmation tests for HAT. The thermostable format of the Card Agglutination Test for Trypanosomiasis (CATT test) was the most appropriate screening test. Lateral flow antibody detection tests could become alternative screening tests in the near future. Confirmation of HAT diagnosis still depends on visualizing the parasite in direct microscopy. All other currently available confirmation tests are either technically too demanding and/or lack sensitivity and thus rather inappropriate for use at health center level. Novel applications of molecular tests may have potential for use at district hospital level.
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Towards Point-of-Care Diagnostic and Staging Tools for Human African Trypanosomiaisis. J Trop Med 2012; 2012:340538. [PMID: 22545057 PMCID: PMC3321554 DOI: 10.1155/2012/340538] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 01/17/2012] [Indexed: 11/18/2022] Open
Abstract
Human African trypanosomiasis is a debilitating disease prevalent in rural sub-Saharan Africa. Control of this disease almost exclusively relies on chemotherapy that should be driven by accurate diagnosis, given the unacceptable toxicity of the few available drugs. Unfortunately, the available diagnostics are characterised by low sensitivities due to the inherent low parasitaemia in natural infections. Demonstration of the trypanosomes in body fluids, which is a prerequisite before treatment, often follows complex algorithms. In this paper, we review the available diagnostics and explore recent advances towards development of novel point-of-care diagnostic tests.
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Wastling SL, Welburn SC. Diagnosis of human sleeping sickness: sense and sensitivity. Trends Parasitol 2011; 27:394-402. [DOI: 10.1016/j.pt.2011.04.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 04/25/2011] [Accepted: 04/28/2011] [Indexed: 11/30/2022]
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Hasker E, Lumbala C, Mbo F, Mpanya A, Kande V, Lutumba P, Boelaert M. Health care-seeking behaviour and diagnostic delays for Human African Trypanosomiasis in the Democratic Republic of the Congo. Trop Med Int Health 2011; 16:869-74. [PMID: 21447063 DOI: 10.1111/j.1365-3156.2011.02772.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE About half of the patients with Human African trypanosomiasis (HAT) reported in the Democratic Republic of the Congo (DRC) are currently detected by fixed health facilities and not by mobile teams. Given the recent policy to integrate HAT control into general health services, we studied health seeking behaviour in these spontaneously presenting patients. METHODS We took a random sample from all patients diagnosed with a first-time HAT episode through passive case finding between 1 October 2008 and 30 September 2009 in the two most endemic provinces of the DRC. Patients were approached at their homes for a structured interview. We documented patient delay (i.e. time between onset of symptoms and contacting a health centre) and health system delay (i.e. time between first contact and correct diagnosis of HAT). RESULTS Median patient delay was 4 months (IQR 1-10 months, n = 66); median health system delay was 3 months (IQR 0.5-11 months). Those first presenting to public health centres had a median systems delay of 7 months (IQR 2-14 months, n = 23). On median, patients were diagnosed upon the forth visit to a health facility (IQR 3rd-7th visit). CONCLUSIONS Substantial patient as well as health system delays are incurred in HAT cases detected passively. Public health centres are performing poorly in the diagnostic work-up for HAT, mainly because HAT is a relatively rare disease with few and non-specific early symptoms. Integration of HAT diagnosis and treatment into general health services requires strong technical support and well-organized supervision and referral mechanisms.
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Affiliation(s)
- E Hasker
- Epidemiology and Disease Control Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
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